Provider Demographics
NPI:1174514509
Name:CAMPBELL NEDELKA, SHANNON CLARKE (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CLARKE
Last Name:CAMPBELL NEDELKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DREYER WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2775
Mailing Address - Country:US
Mailing Address - Phone:603-332-6413
Mailing Address - Fax:603-335-1076
Practice Address - Street 1:7 DREYER WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-2775
Practice Address - Country:US
Practice Address - Phone:603-332-6413
Practice Address - Fax:603-335-1076
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH128072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205273Medicaid
NH01Y008533NH01OtherANTHEM BCBS
NH30205273Medicaid
NH01Y008533NH01OtherANTHEM BCBS